Introduction to Poisoning; a Systematic Review
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International Journal of Pharmacy Teaching & Practices 2015, Vol.6, Issue 4, 2615-.2619 Introduction to Poisoning; A Systematic Review 1 1 1 2 Sumbria Tarlok*, Sharma Amit , Prabhakar Shina , Kosey, Sourabh , Devgan Shalini 1- Department of Pharmacy Practice, I. S. F. College of Pharmacy, Moga, Punjab, India 2- Department of Surgery-II, Guru Gobind Singh Medical College Hospital & Research Centre, Faridkot, Punja b, India. Review Article cause illness or injury. Some poisons cause 1 immediate injury, such as battery acid or Please cite this paper as Sumbria Tarlok*, Sharma Amit , Prabhakar Shina1, Kosey, Sourabh1, Devgan Shalini2. household cleaners. Other poisons may take years Introduction to Poisoning; A Systematic Review. IJPTP, of exposure to create a health problem, such as 2015, 6(4) , 2615-2619. heavy metals (lead, arsenic, mercury). The Centers Corresponding Author: for Disease Control and Prevention (CDC) defines a Mr. Sourabh Kosey, poisoning that occurs by accident as "unintentional Associate Professor, poisoning" and a poisoning that results from a Department of Pharmacy Practice, conscious, will full decision (such as suicide or I.S.F. College of Pharmacy, Moga, Punjab, India homicide) as "intentional poisoning" Unintentional E -mail: [email protected] poisoning includes the use of drugs or chemicals for recreational purposes in excessive amounts, Introduction such as an overdose. Unintentional poisoning also Poison includes the excessive use of drugs or chemicals for The term poison was derived from Latin non-recreational purposes, such as by an infant or word “potionem” a drink; i.e.,drink, eat, child. Intentional poisonings include suicide, such breathe, inject or touch enough of a as medication over dosage (B.R. Sharma et al., chemical (also called a poison or toxin) to 2007). Young children are particularly vulnerable to cause illness or death or poison is derived accidental poisoning in the home, as are elderly from Greek word ‘Toxicon’ which means people, often from confusion. Hospitalized people ‘Poison’. A poison is any substance that is and industrial workers are also vulnerable to harmful to the body when eaten, breathed, accidental poisoning by drugs errors and from injected or absorbed through the skin. Any exposure to toxic chemicals, respectively (Tanuj substance can be poisonous if enough is kanchan et al., 2008). The damage caused by taken. poisoning depends on the poison, the amount Poisoning taken and the age and underlying health of the Poisoning is an important health problem in person who takes it. Some poisons are not very every country of the world. Occupational potent and cause problems only with prolonged exposure to industrial chemicals and exposure or repeated ingestion of large amounts. pesticides, accidental or intentional Other poisons are so potent that just a drop on the exposure to household to pharmaceutical skin can cause severe damage. products and poisoning due to venomous Categories of Poisoning animals, toxic plants and food Poisoning is divided in to 4 broad categories:- contamination, all contribute to morbidity Pharmaceuticals: Paracetamol, Aspirin, and mortality (Lall S.B et al., 2003). The Benzodiazepines, Phenytoin, Tricyclic danger of poisoning range from short-term Antidepressants, Barbiturates, Opioids etc. illness to brain damage, coma and death. Some poisons in very small amounts can 2609 International Journal of Pharmacy Teaching & Practices 2015, Vol.6, Issue 4, 2615-.2619 Insecticides and pesticides: increased substantially in the past decade and this Organophasphate, Chlorine, Pyrethroids, country is the largest market for pesticides for sub Superwarfarin, Furadon, Parathion And Saharan Africa (Leslie London and Ross Bailie Endosulphan. 2001). Plants and Animals: Snake or Scorpian bite, Bees or Wasps sting, Insect sting, Oleander, Dhatura and Oduvanthalai. Chemicals: • Inorganic: Mercury, arsenic, lead, copper, Sulfur and Hair Dye (Paraphenylenediamine). Figure 1.2: Insecticides and Pesticides • Organic: Rotenone, Pyrethrum, Nicotine and Neem Oil. Organophosphate Poisoning It is one of the commonest poisons consumed, as it • Biological: Bacteria and viruses (Salmonella, Norovirus, Norwalk Virus, Campylobacter, E. is easily available. Among the organophosphorous coli, Listeria, Clostridium perfringens). compound, methyl parathion (metacid) is the most Most of victims of travel related poisoning commonly used the other compound is were businessman (67.56%) rest were Dichlorovos (nuvan) (Bhattarai MD et al., 2006). normal and domestic travelers (16.21%) and Organophosphorus poisoning occurs very few were service holder (10.81%) (Howlader commonly in southern India, where farmers form a Mar et al., 2008). Some other victims take significant proportion of the population who poisonous material easily available in the commonly use Organophsphorus compound like household or at work place like rat killer Parathion as Insecticides. Thus, due to the easy (superwarfarin), mosquito repellant accessibility of these compounds, a large number (pyrethroid) ant killer (gamma hexene), of suicidal cases are encountered in this region organo compounds (furadon, parathion, (Subhash Vijay Kumar et al., 2011). endosulphan). They also takes drugs which are available at house (either taken by them or house members) like alprazolam, diazepam, phenytoin, barbiturates, paracetamol, aspirin etc. since all the drugs are easily available over the counter, we also Figure 1.3: OPC Poisoning Substances see lot of multidrug over dosage especially combination of antibiotics, analgesics and Most toxic compounds are Endosulphan, methyl antihistamines. parathion, malathion, oleander seeds (in higher doses), Dhatura, Zinc sulphide and Phosphide. Less toxic compounds are Gammahexene, Pyrethroids and Superwarfarin. Figure 1.1: Multiple tablets (Overdose) Pesticide poisoning It is a major public health problem in Figure 1.4: Oleander Seed and Dhatura Fruit developing countries particularly in setting in Snakes low education and poor regulatory These are found all over the world except in the framework. Pesticide usage in South Africa, arctic, New Zealand and Ireland and are more both agricultural and non agricultural has commonly distributed in temperature and tropical 2610 International Journal of Pharmacy Teaching & Practices 2015, Vol.6, Issue 4, 2615-.2619 countries. Snakes are most likely to bite people die each year from snake bite which is a human beings when they feel threatened, common cause of morbidity and mortality in India startled or provoked and have no means of (Subhash Vijay Kumar et al. 2011). Snake bite is a escape cornered. The Deccan plateau, with large problem of the rural area, where basic health its agricultural land and hot, dry climate facilities are poor and as a result death is common. provides an ideal environment for cobras, The four families of venomous snake’s kraits and vipers (Inamdar et al., 2010). atractaspididae, elapidae, hydrophidae and viperdae contain some 500 species; whereas the fifth family, the colubridae contain 40 species venomous to humans. Less than 200 species have caused clinically severe envenoming, ending in Figure 1.5: Snake poison death or permanent disability (Atta Muhammad The most common symptoms of all chandio, 2000). There are some 300 species of land snakebites are overwhelming fear, which snakes in Pakistan out of which 40 are poisonous. may cause symptoms such The commonest poisonous snake in Pakistan is as nausea and vomiting, diarrhea, vertigo, cobra, viper and krait (Atta Muhammad chandio, fainting, tachycardia and cold, clammy skin. 2000). Dry snakebites and those inflicted by a non- venomous species, can still cause severe injury. There are several reasons for this snake bite area may become infected with the snake's saliva and fangs sometimes harboring pathogenic microbial organisms, Figure 1.6: Snake bite including Clostridium tetani. Infection is often reported with viper bites whose fangs Food poisoning are capable of deep puncture wounds. Bites It is defined as an illness caused by the may cause anaphylaxis in certain people. consumption of food or water contaminated with Most snakes bites, whether by a venomous bacteria and their toxins or with parasites, viruses snake or not, will have some type of local or chemicals. The most common pathogens are effect. There is minor pain and redness in Norovirus, Escherichiacoli, Salmonella, Clostridium over 90 percent of cases, although this varies perfringens, Campylobacter and Staphylococcus depending on the site. Bites by vipers and aureus. some cobras may be extremely painful, with the local tissue sometimes becoming tender and severely swollen within five minutes. This area may also bleed and blister and can eventually lead to tissue necrosis. Other common initial symptoms of pit viper and viper bites include lethargy, Figure 1.7: Food poisoning bleeding, weakness, nausea and vomiting. Hair dye poisoning Symptoms may become more life- It is an emerging as one of the important causes of threatening over time, developing intentional self-harm in the developing world. Hair into hypotension, tachypnea, severe dyes contain paraphenylenediamine and a host of tachycardia, severe internal bleeding, altered other chemicals that can cause rhabdomyolysis, sensorium, kidney failure and respiratory laryngeal edema, severe metabolic acidosis and failure. Snakebite is a common acute medical acute renal failure (J Emerg Trauma Shock. 2009 emergency faced by rural population in May-Aug).